title: Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients.
abstract: Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
authors.affiliation: Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhai
authors.forename: Xue-Ying
authors.initials: XY
authors.lastname: Sun
mesh_terms: D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D006801:Humans; D047589:Leukocyte Reduction Procedures; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009366:Neoplasm Seeding; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D057725:Operative Blood Salvage / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Allogeneic blood transfusion; Hepatocellular carcinoma; Intraoperative blood salvage autotransfusion; Leukocyte depletion filters; Liver transplantation